1
|
Bäckryd E, Thordeman K, Gerdle B, Ghafouri B. Cerebrospinal Fluid Metabolomics Identified Ongoing Analgesic Medication in Neuropathic Pain Patients. Biomedicines 2023; 11:2525. [PMID: 37760966 PMCID: PMC10526053 DOI: 10.3390/biomedicines11092525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) can reasonably be hypothesized to mirror central nervous system pathophysiology in chronic pain conditions. Metabolites are small organic molecules with a low molecular weight. They are the downstream products of genes, transcripts and enzyme functions, and their levels can mirror diseased metabolic pathways. The aim of this metabolomic study was to compare the CSF of patients with chronic neuropathic pain (n = 16) to healthy controls (n = 12). METHODS Nuclear magnetic resonance spectroscopy was used for analysis of the CSF metabolome. Multivariate data analysis by projection discriminant analysis (OPLS-DA) was used to separate information from noise and minimize the multiple testing problem. RESULTS The significant OPLS-DA model identified 26 features out of 215 as important for group separation (R2 = 0.70, Q2 = 0.42, p = 0.017 by CV-ANOVA; 2 components). Twenty-one out of twenty-six features were statistically significant when comparing the two groups by univariate statistics and remained significant at a false discovery rate of 10%. For six out of the top ten metabolite features, the features were absent in all healthy controls. However, these features were related to medication, mainly acetaminophen (=paracetamol), and not to pathophysiological processes. CONCLUSION CSF metabolomics was a sensitive method to detect ongoing analgesic medication, especially acetaminophen.
Collapse
Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | | | | |
Collapse
|
2
|
EEG-based sensory testing reveals altered nociceptive processing in elite endurance athletes. Exp Brain Res 2023; 241:341-354. [PMID: 36520191 PMCID: PMC9894977 DOI: 10.1007/s00221-022-06522-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/03/2022] [Indexed: 12/16/2022]
Abstract
Increased exercise loads, as observed in elite athletes, seem to modulate the subjective pain perception in healthy subjects. The combination of electroencephalography (EEG) and standardized noxious stimulation can contribute to an objective assessment of the somatosensory stimulus processing. We assessed the subjective pain ratings and the electroencephalogram (EEG)-based response after standardized noxious mechanical and thermal stimuli as well as during conditioned pain modulation (CPM) in 26 elite endurance athletes and compared them to 26 recreationally active controls. Elite endurance athletes had consistently stronger somatosensory responses in the EEG to both mechanical and thermal noxious stimuli than the control group. We observed no significant group differences in the subjective pain ratings, which may have been influenced by our statistics and choice of stimuli. The CPM testing revealed that our conditioning stimulus modulated the subjective pain perception only in the control group, whereas the EEG indicated a modulatory effect of the conditioning stimulus on the spectral response only in the athletes group. We conclude that a higher activation in the cortical regions that process nociceptive information may either be an indicator for central sensitization or an altered stimulus salience in the elite endurance athletes' group. Our findings from our CPM testing were limited by our methodology. Further longitudinal studies are needed to examine if exercise-induced changes in the somatosensory system might have a critical impact on the long-term health of athletes.
Collapse
|
3
|
Ghafouri B, Ernberg M, Andréll P, Bäckryd E, Fisher MR, Freund-Levi Y, Grelz H, Gräbel O, Karlsten R, Kosek E, Löfgren M, Ringqvist Å, Rudling K, Stålnacke BM, Sörlén N, Uhlin K, Westergren H, Gerdle B. Swedish Chronic Pain Biobank: protocol for a multicentre registry and biomarker project. BMJ Open 2022; 12:e066834. [PMID: 36450421 PMCID: PMC9717004 DOI: 10.1136/bmjopen-2022-066834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for individual patients based on biomarkers and other patient-related factors, has received increasing attention in different diseases but used less in chronic pain. This cooperative project from all Swedish University Hospitals will investigate whether there are changes in inflammation and metabolism patterns in saliva and blood in chronic pain patients and whether the changes correlate with clinical characteristics and rehabilitation outcomes. METHODS AND ANALYSIS Patients at multidisciplinary pain centres at University Hospitals in Sweden who have chosen to participate in the Swedish Quality Registry for Pain Rehabilitation and healthy sex-matched and age-matched individuals will be included in the study. Saliva and blood samples will be collected in addition to questionnaire data obtained from the register. From the samples, proteins, lipids, metabolites and micro-RNA will be analysed in relation to, for example, diagnosis, pain characteristics, psychological distress, body weight, pharmacological treatment and clinical rehabilitation results using advanced multivariate data analysis and bioinformatics. ETHICS AND DISSEMINATION The study is approved by the Swedish Ethical Review Authority (Dnr 2021-04929) and will be conducted in accordance with the declaration of Helsinki.The results will be published in open access scientific journals and in popular scientific relevant journals such as those from patient organisations. Data will be also presented in scientific meetings, meeting with healthcare organisations and disseminated in different lecturers at the clinics and universities.
Collapse
Affiliation(s)
- Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Karolinska Institute, Stockholm, Sweden
| | - Paulin Andréll
- Region Västra Götaland, Sahlgrenska University Hospital, Östra, department of Anaesthesiology and Intensive Care Medicine, Pain Centre, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marcelo Rivano Fisher
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Yvonne Freund-Levi
- School of Medical Sciences, Örebro University and department of Geriatrics, University Hospital Örebro, Örebro, Sweden
- Department of geriatrics, Södertälje Hospital, Södertälje, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grelz
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Olaf Gräbel
- Region Västra Götaland, Sahlgrenska University Hospital, Östra, department of Anaesthesiology and Intensive Care Medicine, Pain Centre, Sahlgrenska Academy, Gothenburg, Sweden
| | - Rolf Karlsten
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Kosek
- Department Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Rudling
- Department of rehabilitation medicine, University hospital Örebro, Örebro, Sweden
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Niklas Sörlén
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Karin Uhlin
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Hans Westergren
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| |
Collapse
|
4
|
Abstract
Internet-connected devices, including personal computers, smartphones, smartwatches, and voice assistants, have evolved into powerful multisensor technologies that billions of people interact with daily to connect with friends and colleagues, access and share information, purchase goods, play games, and navigate their environment. Digital phenotyping taps into the data streams captured by these devices to characterize and understand health and disease. The purpose of this article is to summarize opportunities for digital phenotyping in neurology, review studies using everyday technologies to obtain motor and cognitive information, and provide a perspective on how neurologists can embrace and accelerate progress in this emerging field.
Collapse
Affiliation(s)
- Anoopum S. Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
Eitner L, Maier C, Brinkmann F, Schlegtendal A, Knoke L, Enax-Krumova E, Lücke T. Somatosensory abnormalities after infection with SARS-CoV-2 - A prospective case-control study in children and adolescents. Front Pediatr 2022; 10:977827. [PMID: 36263148 PMCID: PMC9574195 DOI: 10.3389/fped.2022.977827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-term neurological complaints after SARS-CoV-2 infection occur in 4-66% of children and adolescents. Controlled studies on the integrity of the peripheral nerve system are scarce. Therefore, we examined the somatosensory function in children and adolescents after SARS-CoV-2 infection in a case-control study compared with age-matched individuals. MATERIALS AND METHODS Eighty-one subjects after SARS-CoV-2 infection (n = 44 female, 11.4 ± 3.5 years, n = 75 SARS-CoV-2 seropositive, n = 6 PCR positive during infection and SARS-CoV-2 seronegative at the time point of study inclusion, n = 47 asymptomatic infection) were compared to 38 controls without SARS-CoV-2 infection (26 female, 10.3 ± 3.4 years, n = 15 with other infection within last 6 months). After standardised interviews and neurological examinations, large fibre (tactile and vibration detection thresholds) and small fibre (cold and warm detection thresholds, paradoxical heat sensation) functions were assessed on both feet following a validated protocol. After z-transformation of all values, all participants were compared to published reference values regarding the number of abnormal results. Additionally, the mean for all sensory parameters values of both study groups were compared to an ideal healthy population (with z-value 0 ± 1), as well as with each other, as previously described. Statistical analyses: t-test, Chi-squared test, and binominal test. FINDINGS None of the controls, but 27 of the 81 patients (33%, p < 0.001) reported persistent complaints 2.7 ± 1.9 (0.8-8.5) months after SARS-CoV-2 infection, most often reduced exercise capacity (16%), fatigue (13%), pain (9%), or paraesthesia (6%). Reflex deficits or paresis were missing, but somatosensory profiles showed significantly increased detection thresholds for thermal (especially warm) and vibration stimuli compared to controls. Approximately 36% of the patients after SARS-CoV-2, but none of the controls revealed an abnormal sensory loss in at least one parameter (p < 0.01). Sensory loss was characterised in 26% by large and 12% by small fibre dysfunction, the latter appearing more frequently in children with prior symptomatic SARS-CoV-2 infection. Myalgia/paraesthesia was indicative of somatosensory dysfunction. In all eight re-examined children, the nerve function recovered after 2-4 months. INTERPRETATION This study provides evidence that in a subgroup of children and adolescents previously infected with SARS-CoV-2, regardless of their complaints, the function of large or small nerve fibres is presumably reversibly impaired.
Collapse
Affiliation(s)
- Lynn Eitner
- Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany.,University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Maier
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Folke Brinkmann
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anne Schlegtendal
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Leona Knoke
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Lücke
- Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany.,University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
6
|
Jayakar S, Shim J, Jo S, Bean BP, Singeç I, Woolf CJ. Developing nociceptor-selective treatments for acute and chronic pain. Sci Transl Med 2021; 13:eabj9837. [PMID: 34757806 PMCID: PMC9964063 DOI: 10.1126/scitranslmed.abj9837] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite substantial efforts dedicated to the development of new, nonaddictive analgesics, success in treating pain has been limited. Clinically available analgesic agents generally lack efficacy and may have undesirable side effects. Traditional target-based drug discovery efforts that generate compounds with selectivity for single targets have a high rate of attrition because of their poor clinical efficacy. Here, we examine the challenges associated with the current analgesic drug discovery model and review evidence in favor of stem cell–derived neuronal-based screening approaches for the identification of analgesic targets and compounds for treating diverse forms of acute and chronic pain.
Collapse
Affiliation(s)
- Selwyn Jayakar
- F.M. Kirby Neurobiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Jaehoon Shim
- F.M. Kirby Neurobiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Sooyeon Jo
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Bruce P Bean
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Ilyas Singeç
- National Center for Advancing Translational Sciences (NCATS), Stem Cell Translation Laboratory (SCTL), National Institutes of Health (NIH), Rockville, MD 20850, USA
| | - Clifford J Woolf
- F.M. Kirby Neurobiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
7
|
Yeo M, Chen Y, Jiang C, Chen G, Wang K, Chandra S, Bortsov A, Lioudyno M, Zeng Q, Wang P, Wang Z, Busciglio J, Ji RR, Liedtke W. Repurposing cancer drugs identifies kenpaullone which ameliorates pathologic pain in preclinical models via normalization of inhibitory neurotransmission. Nat Commun 2021; 12:6208. [PMID: 34707084 PMCID: PMC8551327 DOI: 10.1038/s41467-021-26270-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
Inhibitory GABA-ergic neurotransmission is fundamental for the adult vertebrate central nervous system and requires low chloride concentration in neurons, maintained by KCC2, a neuroprotective ion transporter that extrudes intracellular neuronal chloride. To identify Kcc2 gene expression‑enhancing compounds, we screened 1057 cell growth-regulating compounds in cultured primary cortical neurons. We identified kenpaullone (KP), which enhanced Kcc2/KCC2 expression and function in cultured rodent and human neurons by inhibiting GSK3ß. KP effectively reduced pathologic pain-like behavior in mouse models of nerve injury and bone cancer. In a nerve-injury pain model, KP restored Kcc2 expression and GABA-evoked chloride reversal potential in the spinal cord dorsal horn. Delta-catenin, a phosphorylation-target of GSK3ß in neurons, activated the Kcc2 promoter via KAISO transcription factor. Transient spinal over-expression of delta-catenin mimicked KP analgesia. Our findings of a newly repurposed compound and a novel, genetically-encoded mechanism that each enhance Kcc2 gene expression enable us to re-normalize disrupted inhibitory neurotransmission through genetic re-programming.
Collapse
Affiliation(s)
- Michele Yeo
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
| | - Yong Chen
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
| | - Changyu Jiang
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA
| | - Gang Chen
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA
| | - Kaiyuan Wang
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA
| | - Sharat Chandra
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA
| | - Andrey Bortsov
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA
| | - Maria Lioudyno
- Department of Neurobiology & Behavior, Institute for Memory Impairments and Neurological Disorders (iMIND), Center for the Neurobiology of Learning and Memory, University of California at Irvine, Irvine, CA, USA
| | - Qian Zeng
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Peng Wang
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Zilong Wang
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA
| | - Jorge Busciglio
- Department of Neurobiology & Behavior, Institute for Memory Impairments and Neurological Disorders (iMIND), Center for the Neurobiology of Learning and Memory, University of California at Irvine, Irvine, CA, USA
| | - Ru-Rong Ji
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA.
- Department of Neurobiology, Duke University Medical Center, Durham, NC, USA.
| | - Wolfgang Liedtke
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
- Department of Anesthesiology (Center for Translational Pain Medicine), Duke University Medical Center, Durham, NC, USA.
- Department of Neurobiology, Duke University Medical Center, Durham, NC, USA.
- Duke Neurology Clinics for Headache, Head-Pain and Trigeminal Sensory Disorders, Duke University Medical Center, Durham, NC, USA.
- Duke Anesthesiology Clinics for Innovative Pain Therapy, Duke University Medical Center, Durham, NC, USA.
| |
Collapse
|
8
|
Costa YM, Bonjardim LR, Conti PCR, Svensson P. Psychophysical evaluation of somatosensory function in oro-facial pain: achievements and challenges. J Oral Rehabil 2021; 48:1066-1076. [PMID: 34213796 DOI: 10.1111/joor.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
AIM This critical review describes key methodological aspects for a successful oro-facial psychophysical evaluation of the somatosensory system and highlights the diagnostic value of somatosensory assessment and management perspectives based on somatosensory profiling. METHODS This topical review was based on a non-systematic search for studies about somatosensory evaluation in oro-facial pain in PubMed and Embase. RESULTS The recent progress regarding the psychophysical evaluation of somatosensory function was largely possible due to the development and application of valid, reliable and standardised psychophysical methods. Qualitative sensory testing may be useful as a screening tool to rule out relevant somatosensory abnormalities. Nevertheless, the patient should preferably be referred to a more comprehensive assessment with the quantitative sensory testing battery if confirmation of somatosensory abnormalities is necessary. Moreover, the identification of relevant somatosensory alterations in chronic pain disorders that do not fulfil the current criteria to be regarded as neuropathic has also increased the usefulness of somatosensory evaluation as a feasible method to better characterise the patients and perhaps elucidate some underpinnings of the so-called 'nociplastic' pain disorders. Finally, an additional benefit of oro-facial pain treatment based on somatosensory profiling still needs to be demonstrated and convincing evidence of somatosensory findings as predictors of treatment efficacy in chronic oro-facial pain awaits further studies. CONCLUSION Psychophysical evaluation of somatosensory function in oro-facial pain is still in its infancy but with a clear potential to continue to improve the assessment, diagnosis and management of oro-facial pain patients.
Collapse
Affiliation(s)
- Yuri M Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Bauru Orofacial Pain Group, Bauru, Brazil
| | - Leonardo R Bonjardim
- Bauru Orofacial Pain Group, Bauru, Brazil.,Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Paulo César R Conti
- Bauru Orofacial Pain Group, Bauru, Brazil.,Department of Prosthodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, Malmo University, Malmo, Sweden
| |
Collapse
|
9
|
Iwatsuki K, Hoshiyama M, Yoshida A, Uemura JI, Hoshino A, Morikawa I, Nakagawa Y, Hirata H. Chronic pain-related cortical neural activity in patients with complex regional pain syndrome. IBRO Neurosci Rep 2021; 10:208-215. [PMID: 34095892 PMCID: PMC8167223 DOI: 10.1016/j.ibneur.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 11/04/2022] Open
Abstract
Quantitative objective measurement of chronic pain is important. We elucidated chronic pain-related cortical neural activity and neural connectivity among pain-related brain regions in complex regional pain syndrome (CRPS). Resting-state magnetoencephalography recordings were performed. Cortical current density and neural connectivity, revealed by amplitude envelope correlation (AEC), were estimated on standardized brain magnetic resonance imaging. Intra-experiment pain was assessed subjectively using a visual analogue scale (VAS). The correlation between current density and VAS scores was calculated for the occipital areas and pain-related cortices. Current density in the primary (SI) and secondary (SII) somatosensory cortex and precuneus in both hemispheres was negatively correlated with the pain VAS score. The AEC and VAS values were significantly correlated for the SII and the precuneus and for the SII and insular cortex in the alpha frequency band in the right hemisphere. In the theta frequency band, the AEC and VAS values correlated for the SII and posterior cingulate cortex in the right hemisphere. Our results suggested that disruption of pain processes and functions in the default mode network occurs in CRPS. Our method targeting the neural mechanism of pain has the potential to offer a clinically objective means of evaluating it. Chronic pain can be objectively evaluated with magnetoencephalography. Neural connectivity of pain-related cortices was reduced in complex regional pain syndrome. Default mode network is disrupted in complex regional pain syndrome patients.
Collapse
Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Minoru Hoshiyama
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Akihito Yoshida
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Jun-Ichi Uemura
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Aiko Hoshino
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Izumi Morikawa
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Yasunobu Nakagawa
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| |
Collapse
|
10
|
Luo Y, Wang CZ, Sawadogo R, Tan T, Yuan CS. Effects of Herbal Medicines on Pain Management. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:1-16. [PMID: 32054304 DOI: 10.1142/s0192415x20500019] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pain is an unpleasant sensory and emotional experience in many diseases and is often caused by intense or damaging stimuli. Pain negatively affects the quality of life and increases high health expenditures. Drugs with analgesic properties are commonly used to relieve pain, but these Western medications could be overwhelmed by side effects including tolerance and addiction. Herbal medicines may provide alternative measures for pain management. In this review paper, after introduction of Chinese medicine theory and treatment modality, emphasis is placed on the application of Chinese herbs and herbal formulations in pain management. Three of the most commonly used herbs, i.e., Corydalis yanhusuo, Ligusticum chuanxiong, and Aconitum carmichaeli, are reviewed. Subsequently, using this ancient medical remedy, Chinese herbal formulation in treating common medical conditions associated with pain, such as headache/migraine, chest pain, abdominal pain, low back pain, neuropathic pain, osteoarthritis, and cancer pain, is presented. Chinese herbal medicines could be considered as a complementary and integrative approach in the modern armamentarium in combating pain.
Collapse
Affiliation(s)
- Yun Luo
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, P. R. China.,Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Chong-Zhi Wang
- Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Richard Sawadogo
- Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Institute for Health Science Research, 03 BP 7192 Ouagadougou 03, Burkina Faso
| | - Ting Tan
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, P. R. China
| | - Chun-Su Yuan
- Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
| |
Collapse
|
11
|
Gerdle B, Ghafouri B. Proteomic studies of common chronic pain conditions - a systematic review and associated network analyses. Expert Rev Proteomics 2020; 17:483-505. [DOI: 10.1080/14789450.2020.1797499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
12
|
Moss RA. Psychotherapy in pain management: New viewpoints and treatment targets based on a brain theory. AIMS Neurosci 2020; 7:194-207. [PMID: 32995484 PMCID: PMC7519970 DOI: 10.3934/neuroscience.2020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022] Open
Abstract
The current paper provides an explanation of neurophysiological pain processing based the Dimensional Systems Model (DSM), a theory of higher cortical functions in which the cortical column is considered the binary digit for all cortical functions. Within the discussion, novel views on the roles of the basal ganglia, cerebellum, and cingulate cortex are presented. Additionally, an applied Clinical Biopsychological Model (CBM) based on the DSM will be discussed as related to psychological treatment with chronic pain patients. Three specific areas that have not been adequately addressed in the psychological treatment of chronic pain patients will be discussed based on the CBM. The treatment approaches have been effectively used in a clinical setting. Conclusions focus on a call for researchers and clinicians to fully evaluate the value of both the DSM and CBM.
Collapse
Affiliation(s)
- Robert A. Moss
- North Mississippi Regional Pain Consultants, 4381 Eason Blvd., Tupelo, MS 38801 USA
| |
Collapse
|
13
|
Zibura AE, Salmon JH, Belda Lopez B, X Lascelles BD, Westermeyer HD. Glaucoma-associated pain results in mechanical sensitivity changes in dogs: A pilot study. Vet Ophthalmol 2020; 24 Suppl 1:116-124. [PMID: 32608141 DOI: 10.1111/vop.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To explore the effects of chronic, uncontrolled glaucoma on pressure sensitivity in dogs before and after enucleation of the painful globe. METHODS Client-owned dogs undergoing enucleation for chronic glaucoma with no other sources of pain were enrolled. Normal dogs of similar breeds and skull morphology were enrolled as controls. Craniofacial ratio (CFR) and relative palpebral fissure width (RPFW) were assessed in all patients. Serial mechanical quantitative sensory testing (QST) was performed the day before surgery, and 14, 30, 60, and 120 days after surgery. QST consisted of electronic Von Frey (eVF), and blunt algometry (BA) performed above and below the nonglaucomatous eye, the metacarpus, and metatarsus. Cochet-Bonnet esthesiometry (CB) was also performed on the remaining eye. RESULTS Twelve dogs (6 per group) were included. Compared to baseline values, sensitivity tended to decrease over time (increased thresholds) in treatment dogs while it stayed constant or increased slightly in control dogs. The difference in change from baseline sensitivity between control and treatment groups was significant at day 120 using BA at supraorbital (P = .0153), infraorbital (P = .0209), and metacarpal sites (P = .007) and overall (P = .0470). This divergence was also significant using CB (P = .0470) on the opposite cornea. As patient CFR and RPFWV increased, both eVF (P = .005-.023) and BA (P = .004-.041) increased. CONCLUSIONS Sensitivity to mechanical stimuli decreased both locally and at remote sites in dogs following enucleation for painful chronic glaucoma. Cranial conformation is associated with differences in sensitivity.
Collapse
Affiliation(s)
- Ashley E Zibura
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Jacklyn H Salmon
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Beatriz Belda Lopez
- Small Animal Surgery, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - B Duncan X Lascelles
- Small Animal Surgery, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Comparative Pain Research and Education Center, North Carolina State University, Raleigh, NC, USA
| | - Hans D Westermeyer
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| |
Collapse
|
14
|
Kortenjann AC, Banzer W, Fleckenstein J. Sub-maximal endurance exercise does not mediate alterations of somatosensory thresholds. Sci Rep 2020; 10:10782. [PMID: 32612194 PMCID: PMC7329805 DOI: 10.1038/s41598-020-67700-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/10/2020] [Indexed: 11/09/2022] Open
Abstract
Physical exercise has been shown to alter sensory functions, such as sensory detection or perceived pain. However, most contributing studies rely on the assessment of single thresholds, and a systematic testing of the sensory system is missing. This randomised, controlled cross-over study aims to determine the sensory phenotype of healthy young participants and to assess if sub-maximal endurance exercise can impact it. We investigated the effects of a single bout of sub-maximal running exercise (30 min at 80% heart rate reserve) compared to a resting control in 20 healthy participants. The sensory profile was assessed applying quantitative sensory testing (QST) according to the protocol of the German Research Network on Neuropathic Pain. QST comprises a broad spectrum of thermal and mechanical detection and pain thresholds. It was applied to the forehead of study participants prior and immediately after the intervention. Time between cross-over sessions was one week. Sub-maximal endurance exercise did not significantly alter thermal or mechanical sensory function (time × group analysis) in terms of detection and pain thresholds. The sensory phenotypes did not indicate any clinically meaningful deviation of sensory function. The alteration of sensory thresholds needs to be carefully interpreted, and only systematic testing allows an improved understanding of mechanism. In this context, sub-maximal endurance exercise is not followed by a change of thermal and mechanical sensory function at the forehead in healthy volunteers.
Collapse
Affiliation(s)
- Ann-Christin Kortenjann
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University of Frankfurt, Ginnheimer Landstr. 39, 60487, Frankfurt am Main, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University of Frankfurt, Ginnheimer Landstr. 39, 60487, Frankfurt am Main, Germany.,Institute of Occupational, Social and Environmental Medicine, Goethe-University, 60590, Frankfurt, Germany
| | - Johannes Fleckenstein
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University of Frankfurt, Ginnheimer Landstr. 39, 60487, Frankfurt am Main, Germany.
| |
Collapse
|
15
|
Kirketeig T, Schultheis C, Zuidema X, Hunter CW, Deer T. Burst Spinal Cord Stimulation: A Clinical Review. PAIN MEDICINE 2020; 20:S31-S40. [PMID: 31152175 PMCID: PMC6544556 DOI: 10.1093/pm/pnz003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective Clinical review on outcomes using burst spinal cord stimulation (SCS) in the treatment of chronic, intractable pain. Design Narrative clinical literature review conducted utilizing a priori search terms including key words for burst spinal cord stimulation. Synthesis and reporting of data from publications including an overview of comparative SCS outcomes. Results Burst SCS demonstrated greater pain relief over tonic stimulation in multiple studies, which included blinded, sham-controlled, randomized trials. Additionally, burst stimulation impacts multiple dimensions of pain, including somatic pain as well as emotional and psychological elements. Patient preference is weighted toward burst over tonic due to increased pain relief, a lack of paresthesias, and impression of change in condition. Conclusion Burst SCS has been shown to be both statistically and clinically superior to tonic stimulation and may provide additional benefits through different mechanisms of action. Further high-quality controlled studies are warranted to not only elucidate the basic mechanisms of burst SCS but also address how this unique stimulation signature/pattern may more adequately handle the multiple affective dimensions of pain in varying patient populations.
Collapse
Affiliation(s)
- Terje Kirketeig
- Multidisciplinary Pain Clinic, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Carsten Schultheis
- Departement für Interventionelle Schmerzmedizin, Krankenhaus Neuwerk "Maria von den Aposteln" Muskulo-Skeletales Zentrum Mönchengladbach, Germany
| | - Xander Zuidema
- Department of Anesthesiology and Pain Management, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Corey W Hunter
- Ainsworth Institute of Pain Management, New York, New York
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
| |
Collapse
|
16
|
Wasan AD, Alter BJ, Edwards RR, Argoff CE, Sehgal N, Walk D, Moeller-Bertram T, Wallace MS, Backonja M. Test-Retest and Inter-Examiner Reliability of a Novel Bedside Quantitative Sensory Testing Battery in Postherpetic Neuralgia Patients. THE JOURNAL OF PAIN 2019; 21:858-868. [PMID: 31837446 DOI: 10.1016/j.jpain.2019.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 11/09/2019] [Accepted: 11/17/2019] [Indexed: 12/17/2022]
Abstract
In health and disease, the somatosensory system has been interrogated with standardized research techniques, collectively referred to as quantitative sensory testing (QST). In neuropathic pain, QST has been used to characterize multiple sensory derangements. However, the use of QST outside the lab has been limited by several factors, including a lack of standardization, variability in procedural technique, and duration of testing that would be unacceptable for clinic. To address these shortcomings, the Neuropathic Pain Research Consortium designed an easy and low-cost "bedside" QST procedure. To test the hypothesis that this procedure would be clinically reliable over time and across different examiners, a multisite, blinded study was performed in subjects with postherpetic neuralgia. Generally, agreement between 2 examiners and over 2 study visits with 1 examiner was high. Additionally, intraclass correlation coefficients and Kappa statistics calculated showed that the battery of QST tests included were highly reliable. Interestingly, mechanical modalities (light brush, pinprick, pressure, and vibration) showed the highest reliability. The least reliable modalities were cool (room temperature) and warmth (38°C). These data demonstrate that the Neuropathic Pain Research Consortium beside QST protocol is reliable across examiner and over time, providing a validated QST tool for use in clinical practice and clinical trials. PERSPECTIVE: This blinded, multicenter trial in 32 patients with postherpetic neuralgia demonstrates bedside QST is reliable and suitable as a clinical trial outcome. The novel bedside battery could be used in clinical trials or in clinical practice over time given the reliability data presented in this article.
Collapse
Affiliation(s)
- Ajay D Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pennsylvania
| | - Benedict J Alter
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pennsylvania.
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Charles E Argoff
- Department of Neurology, Albany Medical College, Albany, New York
| | - Nalini Sehgal
- Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin, Madison, Wisconsin
| | - David Walk
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | | | - Mark S Wallace
- Department of Anesthesiology, University of California San Diego, San Diego, California
| | - Misha Backonja
- Department of Anesthesiology, University of Washington, Seattle, Washington
| |
Collapse
|
17
|
Lee KY, Ratté S, Prescott SA. Excitatory neurons are more disinhibited than inhibitory neurons by chloride dysregulation in the spinal dorsal horn. eLife 2019; 8:e49753. [PMID: 31742556 PMCID: PMC6887484 DOI: 10.7554/elife.49753] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/18/2019] [Indexed: 01/22/2023] Open
Abstract
Neuropathic pain is a debilitating condition caused by the abnormal processing of somatosensory input. Synaptic inhibition in the spinal dorsal horn plays a key role in that processing. Mechanical allodynia - the misperception of light touch as painful - occurs when inhibition is compromised. Disinhibition is due primarily to chloride dysregulation caused by hypofunction of the potassium-chloride co-transporter KCC2. Here we show, in rats, that excitatory neurons are disproportionately affected. This is not because chloride is differentially dysregulated in excitatory and inhibitory neurons, but, rather, because excitatory neurons rely more heavily on inhibition to counterbalance strong excitation. Receptive fields in both cell types have a center-surround organization but disinhibition unmasks more excitatory input to excitatory neurons. Differences in intrinsic excitability also affect how chloride dysregulation affects spiking. These results deepen understanding of how excitation and inhibition are normally balanced in the spinal dorsal horn, and how their imbalance disrupts somatosensory processing.
Collapse
Affiliation(s)
- Kwan Yeop Lee
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoCanada
| | - Stéphanie Ratté
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoCanada
| | - Steven A Prescott
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoCanada
| |
Collapse
|
18
|
Fish Response to Turbulence Generated Using Multiple Randomly Actuated Synthetic Jet Arrays. WATER 2019. [DOI: 10.3390/w11081715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hydroelectric power stations generate turbulent flow conditions, which represent a potentially significant hydraulic stressor to fish passing through the turbine system. A test facility has been developed using two randomly actuated synthetic jet arrays (RASJAs) of 25 independent submersible pumps to generate a turbulent flow field for biological dose-response testing. The novel elements of this approach include the ability to control the exposure duration within a test volume due to low mean flow velocity as well as the capacity to scale the turbulence levels as a function of pump capacity. Juvenile Chinook salmon (Oncorhynchus tshawytscha) were subjected to the turbulent flow regime with average turbulence kinetic energy per unit mass of 0.089 m 2 / s 2 for periods of 2 min and 10 min. No significant loss of equilibrium or disorientation was observed after exposure for either duration at the level of turbulence achieved in this prototype. Further scaling of this approach is required to generate a complete dose-response relationship.
Collapse
|
19
|
Price TJ, Gold MS. From Mechanism to Cure: Renewing the Goal to Eliminate the Disease of Pain. PAIN MEDICINE 2019; 19:1525-1549. [PMID: 29077871 DOI: 10.1093/pm/pnx108] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective Persistent pain causes untold misery worldwide and is a leading cause of disability. Despite its astonishing prevalence, pain is undertreated, at least in part because existing therapeutics are ineffective or cause intolerable side effects. In this review, we cover new findings about the neurobiology of pain and argue that all but the most transient forms of pain needed to avoid tissue damage should be approached as a disease where a cure can be the goal of all treatment plans, even if attaining this goal is not yet always possible. Design We reviewed the literature to highlight recent advances in the area of the neurobiology of pain. Results We discuss barriers that are currently hindering the achievement of this goal, as well as the development of new therapeutic strategies. We also discuss innovations in the field that are creating new opportunities to treat and even reverse persistent pain, some of which are in late-phase clinical trials. Conclusion We conclude that the confluence of new basic science discoveries and development of new technologies are creating a path toward pain therapeutics that should offer significant hope of a cure for patients and practitioners alike. Classification of Evidence. Our review points to new areas of inquiry for the pain field to advance the goal of developing new therapeutics to treat chronic pain.
Collapse
Affiliation(s)
- Theodore J Price
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
| | - Michael S Gold
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
20
|
Kaliyaperumal S, Wilson K, Aeffner F, Dean C. Animal Models of Peripheral Pain: Biology Review and Application for Drug Discovery. Toxicol Pathol 2019; 48:202-219. [PMID: 31269874 DOI: 10.1177/0192623319857051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pain is a complex constellation of cognitive, unpleasant sensory, and emotional experiences that primarily serves as a survival mechanism. Pain arises in the peripheral nervous system and pain signals synapse with nerve tracts extending into the central nervous system. Several different schemes are used to classify pain, including the underlying mechanism, tissues primarily affected, and time-course. Numerous animal models of pain, which should be employed with appropriate Institutional Animal Care and Use approvals, have been developed to elucidate pathophysiology mechanisms and aid in identification of novel therapeutic targets. The variety of available models underscores the observations that pain phenotypes are driven by several distinct mechanisms. Pain outcome measurement encompasses both reflexive (responses to heat, cold, mechanical and electrical stimuli) and nonreflexive (spontaneous pain responses to stimuli) behaviors. However, the question of translatability to human pain conditions and potential treatment outcomes remains a topic of continued scrutiny. In this review we discuss the different types of pain and their mechanisms and pathways, available rodent pain models with an emphasis on type of pain stimulations and pain outcome measures and discuss the role of pathologists in assessing and validating pain models.
Collapse
Affiliation(s)
| | | | | | - Charles Dean
- Amgen, Inc, Thousand Oaks, CA, USA *Both authors equally contributed to the manuscript
| |
Collapse
|
21
|
Fleckenstein J, Banzer W. A review of hands-on based conservative treatments on pain in recreational and elite athletes. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
22
|
Abstract
Peripheral nerve injuries and diseases often lead to pain persisting beyond the resolution of damage, indicating an active disease-promoting process, which may result in chronic pain. This is regarded as a maladaptive mechanism resulting from neuroinflammation that originally serves to promote regeneration and healing. Knowledge on these physiological and pathophysiological processes has accumulated over the last few decades and has started to yield potential therapeutic targets. Key players are macrophages, T-lymphocytes, cytokines, and chemokines. In the spinal cord and brain, microglia and astrocytes are involved. Recently, data have been emerging on the regulation of these players. MicroRNAs and other noncoding RNAs have been discussed as potential master switches that may link nerve injury, pain, and inflammation. Clinical disorders most intensely studied in the context of neuroinflammation and pain are the complex regional pain syndrome, polyneuropathies, postherpetic neuralgia, and the fibromyalgia syndrome, in which recently a neuropathic component has been described. Research from several groups has shown an important role of both proinflammatory and anti-inflammatory cytokines in neuropathic and other chronic pain states in humans. There is ample evidence of an analgesic action of anti-inflammatory cytokines in animal models. The interplay of anti-inflammatory cytokines and the nociceptive system provides possibilities and challenges concerning treatment strategies based on this concept.
Collapse
|
23
|
Basha ME, Kellogg-Spadt S, Burrows LJ, Ruberu MS, Wallach AS, Nazar AM, Whitmore KE. Thermal and Mechanical Pain Thresholds of Women With Provoked Localized Vulvodynia: A Pilot Study. ACTA ACUST UNITED AC 2019; 119:164-172. [PMID: 30801112 DOI: 10.7556/jaoa.2019.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Vulvodynia is a chronic pain condition defined as vulvar pain lasting at least 3 months in the absence of gross anatomic or neurologic findings. Provoked, localized vulvodynia (PLV), a subtype of vulvodynia, is characterized by vestibular pain in response to light touch. The cause of PLV remains largely unknown, and triggering events have yet to be determined. Objective To evaluate vestibular and peripheral experimental pain thresholds in patients with PLV to further define the somatosensory profile of these patients. Methods After informed consent was provided, eligible participants completed a questionnaire and underwent quantitative sensory testing at the forearm and posterior vestibule. Detection and pain thresholds to thermal (cold and heat) and mechanical (pressure) stimuli were measured. Results Seventeen participants with PLV and 16 control participants were included. Participants in the PLV group scored lower on the patient health questionnaire 9 (PHQ-9) compared with those in the control group (P<.05) and had higher ratings of self-reported genital pain with sex (P<.001) and daily activity (P<.05). Forearm pain thresholds to cold (P<.01) and heat (P<.01) stimuli were also lower in the PLV group compared with those in the control group. Vestibular pain thresholds to cold (P<.05) and pressure (P<.01) stimuli were also lower in the PLV group. Conclusion Lower scores on the PHQ-9 and higher self-reported genital pain ratings of patients with PLV highlight the significant impact of this poorly understood condition on quality of life. Quantitative sensory testing results demonstrated that vestibular cold allodynia may be a somatosensory feature of PLV. Reduced forearm pain thresholds in these patients suggest altered sensory processing at extrapelvic sites, although it is unclear whether these measurements are related to central sensitization.
Collapse
|
24
|
Cuomo A, Bimonte S, Forte CA, Botti G, Cascella M. Multimodal approaches and tailored therapies for pain management: the trolley analgesic model. J Pain Res 2019; 12:711-714. [PMID: 30863143 PMCID: PMC6388734 DOI: 10.2147/jpr.s178910] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Chronic pain is described as a manifestation of real or potential tissue damage. It is identified as a perception influenced by the complex interactions of biological, psychological, and social factors. Different types of pain and their comorbidities dramatically affect patients’ quality of life and their families. Due to diverse etiology and pathogenesis, pain management represents a controversial issue in clinical practice. In 1986, the WHO developed a three-step ladder model based on the use of analgesics for pain management according to pain intensity in a linear up or down movement. Despite its huge value for pain relief, this model has some limitations, and some controversies in the pharmacotherapy of pain management have arisen so far. To bypass these difficulties, the concept of WHO analgesic ladder has been contested and changed into a four bidirectional step model which postulates the use of the invasive procedures (neuromodulatory and neurosurgical procedures). Moreover, with the introduction of the neuromatrix theory for dealing the acute and the chronic pain, the WHO model was newly reinterpreted and changed into a platform analgesic model that includes multimodal pharmacological and alternative treatments applicable to all pain conditions, although excludes the precision therapies. Here, we summarize and revise these concepts in order to propose a new model termed “trolley analgesic model” that will allow adopting tailored therapies with dynamic multimodal approaches for pain management according to 1) the pain intensity, 2) the physiopathology of pain, 3) the complexity of symptoms, 4) the presence of comorbidity, and 5) the physiopathological factors and the social context.
Collapse
Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS - Fondazione G Pascale, Naples, Italy,
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS - Fondazione G Pascale, Naples, Italy,
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS - Fondazione G Pascale, Naples, Italy,
| | - Gerardo Botti
- Scientific Direction, Istituto Nazionale Tumori, IRCCS -Fondazione G Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS - Fondazione G Pascale, Naples, Italy,
| |
Collapse
|
25
|
Gomez-Varela D, Barry AM, Schmidt M. Proteome-based systems biology in chronic pain. J Proteomics 2019; 190:1-11. [DOI: 10.1016/j.jprot.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 02/07/2023]
|
26
|
Gonçalves TC, Benoit E, Partiseti M, Servent D. The Na V1.7 Channel Subtype as an Antinociceptive Target for Spider Toxins in Adult Dorsal Root Ganglia Neurons. Front Pharmacol 2018; 9:1000. [PMID: 30233376 PMCID: PMC6131673 DOI: 10.3389/fphar.2018.01000] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Although necessary for human survival, pain may sometimes become pathologic if long-lasting and associated with alterations in its signaling pathway. Opioid painkillers are officially used to treat moderate to severe, and even mild, pain. However, the consequent strong and not so rare complications that occur, including addiction and overdose, combined with pain management costs, remain an important societal and economic concern. In this context, animal venom toxins represent an original source of antinociceptive peptides that mainly target ion channels (such as ASICs as well as TRP, CaV, KV and NaV channels) involved in pain transmission. The present review aims to highlight the NaV1.7 channel subtype as an antinociceptive target for spider toxins in adult dorsal root ganglia neurons. It will detail (i) the characteristics of these primary sensory neurons, the first ones in contact with pain stimulus and conveying the nociceptive message, (ii) the electrophysiological properties of the different NaV channel subtypes expressed in these neurons, with a particular attention on the NaV1.7 subtype, an antinociceptive target of choice that has been validated by human genetic evidence, and (iii) the features of spider venom toxins, shaped of inhibitory cysteine knot motif, that present high affinity for the NaV1.7 subtype associated with evidenced analgesic efficacy in animal models.
Collapse
Affiliation(s)
- Tânia C Gonçalves
- Sanofi R&D, Integrated Drug Discovery - High Content Biology, Paris, France.,Service d'Ingénierie Moléculaire des Protéines, CEA de Saclay, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Evelyne Benoit
- Service d'Ingénierie Moléculaire des Protéines, CEA de Saclay, Université Paris-Saclay, Gif-sur-Yvette, France.,Institut des Neurosciences Paris-Saclay, UMR CNRS/Université Paris-Sud 9197, Gif-sur-Yvette, France
| | - Michel Partiseti
- Sanofi R&D, Integrated Drug Discovery - High Content Biology, Paris, France
| | - Denis Servent
- Service d'Ingénierie Moléculaire des Protéines, CEA de Saclay, Université Paris-Saclay, Gif-sur-Yvette, France
| |
Collapse
|
27
|
De Gregori M, Belfer I, De Giorgio R, Marchesini M, Muscoli C, Rondanelli M, Martini D, Mena P, Arranz LI, Lorente-Cebrián S, Perna S, Villarini A, Salamone M, Allegri M, Schatman ME. Second edition of SIMPAR's "Feed Your Destiny" workshop: the role of lifestyle in improving pain management. J Pain Res 2018; 11:1627-1636. [PMID: 30214272 PMCID: PMC6118253 DOI: 10.2147/jpr.s160660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This review is aimed to summarize the latest data regarding pain and nutrition, which have emerged during the second edition of Feed Your Destiny (FYD). Theme presentations and interactive discussions were held at a workshop on March 30, 2017, in Florence, Italy, during the 9th Annual Meeting of Study in Multidisciplinary Pain Research, where an international faculty, including recognized experts in nutrition and pain, reported the scientific evidence on this topic from various perspectives. Presentations were divided into two sections. In the initial sessions, we analyzed the outcome variables and methods of measurement for health claims pertaining to pain proposed under Regulation EC No 1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods. Moreover, we evaluated how the Mediterranean diet can have a potential impact on pain, gastrointestinal disorders, obesity, cancer, and aging. Second, we discussed the evidence regarding vitamin D as a nutraceutical that may contribute to pain control, evaluating the interindividual variability of pain nature and nurture, and the role of micro-RNAs (miRNAs), polyunsaturated omega 3 fatty acids, and phenolic compounds, with a final revision of the clinical role of nutrition in tailoring pain therapy. The key take-home message provided by the FYD workshop was that a balanced, personalized nutritional regimen might play a role as a synergic strategy that can improve management of chronic pain through a precision medicine approach.
Collapse
Affiliation(s)
- Manuela De Gregori
- Pain Therapy Service, Fondazione IRCCS Polclinico San Matteo, Pavia, Italy, .,Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Young Against Pain Group, Parma, Italy,
| | - Inna Belfer
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Roberto De Giorgio
- Department of Clinical Sciences, Nuovo Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Maurizio Marchesini
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Young Against Pain Group, Parma, Italy, .,Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliero, Universitaria of Parma, Parma, Italy
| | - Carolina Muscoli
- Department of Health Sciences, Institute of Research for Food Safety and Health, University "Magna Graecia" of Catanzaro, Parma, Italy
| | - Mariangela Rondanelli
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Department of Public Health, Section of Human Nutrition and Dietetics, Azienda di Servizi alla Persona di Pavia, University of Pavia, Pavia, Italy
| | - Daniela Martini
- Human Nutrition Unit, Department of Food & Drugs, University of Parma, Parma, Italy
| | - Pedro Mena
- Human Nutrition Unit, Department of Food & Drugs, University of Parma, Parma, Italy
| | - Laura Isabel Arranz
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Department of Nutrition, Food Sciences and Gastronomy, University of Barcelona, Barcelona, Spain
| | - Silvia Lorente-Cebrián
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy, Center for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Simone Perna
- Department of Public Health, Section of Human Nutrition and Dietetics, Azienda di Servizi alla Persona di Pavia, University of Pavia, Pavia, Italy
| | - Anna Villarini
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurizio Salamone
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Science department, Metagenics Italia srl, Milano, Italy.,Società internazionale di Neuropsicocardiologia, Trapani, Italy
| | - Massimo Allegri
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Anesthesia and Intensive Care Service - IRCCS MultiMedica Hospital, Sesto San Giovanni, Milano, Italy
| | - Michael E Schatman
- Study in Multidisciplinary Pain Research Group, Parma, Italy, .,Research and Network Development, Boston Pain Care, Waltham, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
28
|
Barry AM, Sondermann JR, Sondermann JH, Gomez-Varela D, Schmidt M. Region-Resolved Quantitative Proteome Profiling Reveals Molecular Dynamics Associated With Chronic Pain in the PNS and Spinal Cord. Front Mol Neurosci 2018; 11:259. [PMID: 30154697 PMCID: PMC6103001 DOI: 10.3389/fnmol.2018.00259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/10/2018] [Indexed: 12/27/2022] Open
Abstract
To obtain a thorough understanding of chronic pain, large-scale molecular mapping of the pain axis at the protein level is necessary, but has not yet been achieved. We applied quantitative proteome profiling to build a comprehensive protein compendium of three regions of the pain neuraxis in mice: the sciatic nerve (SN), the dorsal root ganglia (DRG), and the spinal cord (SC). Furthermore, extensive bioinformatics analysis enabled us to reveal unique protein subsets which are specifically enriched in the peripheral nervous system (PNS) and SC. The immense value of these datasets for the scientific community is highlighted by validation experiments, where we monitored protein network dynamics during neuropathic pain. Here, we resolved profound region-specific differences and distinct changes of PNS-enriched proteins under pathological conditions. Overall, we provide a unique and validated systems biology proteome resource (summarized in our online database painproteome.em.mpg.de), which facilitates mechanistic insights into somatosensory biology and chronic pain—a prerequisite for the identification of novel therapeutic targets.
Collapse
Affiliation(s)
- Allison M Barry
- Max-Planck Institute of Experimental Medicine, Somatosensory Signaling and Systems Biology Group, Goettingen, Germany
| | - Julia R Sondermann
- Max-Planck Institute of Experimental Medicine, Somatosensory Signaling and Systems Biology Group, Goettingen, Germany
| | - Jan-Hendrik Sondermann
- Max-Planck Institute of Experimental Medicine, Somatosensory Signaling and Systems Biology Group, Goettingen, Germany
| | - David Gomez-Varela
- Max-Planck Institute of Experimental Medicine, Somatosensory Signaling and Systems Biology Group, Goettingen, Germany
| | - Manuela Schmidt
- Max-Planck Institute of Experimental Medicine, Somatosensory Signaling and Systems Biology Group, Goettingen, Germany
| |
Collapse
|
29
|
Association of Parkinson's disease-related pain with plasma interleukin-1, interleukin-6, interleukin-10, and tumour necrosis factor-α. Neurosci Lett 2018; 683:181-184. [PMID: 30063943 DOI: 10.1016/j.neulet.2018.07.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the association between Parkinson's disease (PD)-related pain and plasma interleukin (IL)‑1, IL‑6, IL‑10, and tumour necrosis factor (TNF)‑α levels. METHODS Sixty-seven participants were enrolled. Plasma inflammatory cytokine levels of IL-1, IL-6, IL-10, and TNF-α were measured with enzyme-linked immunosorbent assay. We additionally administered the third part of the Unified Parkinson's Disease Rating Scale (UPDRS III) and Hoehn and Yahr (H-Y) scale stage and recorded the course of the disease, the type and location of the pain, and the use of drugs. RESULTS The level of IL-1 was significantly higher in the PD-with-pain than in the healthy-control group (P < 0.05). There was no significant difference among groups in the other examined cytokine levels. There was a statistically significant difference between the PD-with-pain and the PD-without-pain groups in UPDRS III and H-Y stage. Additionally, the IL-1 level was significantly higher in patients who received a levodopa dosage of >250 mg than in their counterparts who received ≤250 mg, and the IL-1 level was higher in patients with an H-Y stage of >2 and UPDRS III of >27 than in their counterparts with an H-Y stage of ≤2 and UPDRS III of ≤27. The expression of TNF-α was higher in patients aged ≥70 years than in their counterparts aged <70 years. The level of IL-10 was significantly lower in the patients with an H-Y stage of >2 than in their counterparts with an H-Y stage of ≤2. CONCLUSION The elevated level of IL-1 and the depressed level of IL-10 in the peripheral blood of patients with PD-related pain suggests that certain inflammatory cytokines may be implicated in the occurrence and clinical symptoms of PD-related pain.
Collapse
|
30
|
Morlion B, Coluzzi F, Aldington D, Kocot-Kepska M, Pergolizzi J, Mangas AC, Ahlbeck K, Kalso E. Pain chronification: what should a non-pain medicine specialist know? Curr Med Res Opin 2018. [PMID: 29513044 DOI: 10.1080/03007995.2018.1449738] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary care physicians/non-pain medicine specialists lack enough awareness, education and skills to manage pain patients appropriately, and there is currently no clear, common consensus/formal definition of "pain chronification". METHODS This article, based on an international Change Pain Chronic Advisory Board meeting which was held in Wiesbaden, Germany, in October 2016, provides primary care physicians/non-pain medicine specialists with a narrative overview of pain chronification, including underlying physiological and psychosocial processes, predictive factors for pain chronification, a brief summary of preventive strategies, and the role of primary care physicians and non-pain medicine specialists in the holistic management of pain chronification. RESULTS Based on currently available evidence, we propose the following consensus-based definition of pain chronification which provides a common framework to raise awareness among non-pain medicine specialists: "Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification." CONCLUSIONS Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.
Collapse
Affiliation(s)
- Bart Morlion
- a Leuven Centre for Algology & Pain Management , University Hospitals Leuven , KU Leuven , Belgium
| | - Flaminia Coluzzi
- b Department of Medical and Surgical Sciences and Biotechnologies Unit of Anaesthesia, Intensive Care and Pain Medicine , Sapienza University of Rome , Rome , Italy
| | | | - Magdalena Kocot-Kepska
- d Department of Pain Research and Treatment , Jagiellonian University Medical College , Kraków , Poland
| | - Joseph Pergolizzi
- e Global Pain Initiative, Golden, CO, USA and Naples Anesthesia and Pain Associates , Naples , FL , USA
| | | | | | - Eija Kalso
- h Pain Clinic, Departments of Anaesthesiology , Intensive Care, and Pain Medicine, Helsinki University Central Hospital , Helsinki , Finland
| |
Collapse
|
31
|
St John Smith E. Advances in understanding nociception and neuropathic pain. J Neurol 2018; 265:231-238. [PMID: 29032407 PMCID: PMC5808094 DOI: 10.1007/s00415-017-8641-6] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/11/2022]
Abstract
Pain results from the activation of a subset of sensory neurones termed nociceptors and has evolved as a "detect and protect" mechanism. However, lesion or disease in the sensory system can result in neuropathic pain, which serves no protective function. Understanding how the sensory nervous system works and what changes occur in neuropathic pain are vital in identifying new therapeutic targets and developing novel analgesics. In recent years, technologies such as optogenetics and RNA-sequencing have been developed, which alongside the more traditional use of animal neuropathic pain models and insights from genetic variations in humans have enabled significant advances to be made in the mechanistic understanding of neuropathic pain.
Collapse
Affiliation(s)
- Ewan St John Smith
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK.
| |
Collapse
|
32
|
Luchting B, Hinske LCG, Rachinger-Adam B, Celi LA, Kreth S, Azad SC. Soluble intercellular adhesion molecule-1: a potential biomarker for pain intensity in chronic pain patients. Biomark Med 2017; 11:265-276. [PMID: 28240097 DOI: 10.2217/bmm-2016-0246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM Pain therapy is strongly guided by patients' self-reporting. However, when self-reporting is not an option, pain assessment becomes a challenge and may lead to undertreatment of painful conditions. Pain is a complex and multifactorial phenomenon. Recent work has connected pain pathophysiology also with the inflammatory system. We therefore hypothesized that pain intensity could be predicted by cytokine-levels. PATIENTS & METHODS In this observational, single-center study, we investigated 30 serum cytokines to predict pain intensity in a screening/follow-up set of 95 chronic pain patients and controls. We then prospectively validated soluble intercellular adhesion molecule-1 (sICAM-1)'s discriminatory capability (n = 21). RESULTS & CONCLUSION sICAM-1 was significantly associated with patient-reported pain intensity and yielded differential serum levels in patients of varying degrees of pain intensity. Changes in pain ratings over time correlated with changes in sICAM-1 levels. Our findings suggest the possibility of a clinical use of sICAM-1 as a potential biomarker for pain intensity.
Collapse
Affiliation(s)
- Benjamin Luchting
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
| | | | - Banafscheh Rachinger-Adam
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
| | - Leo Anthony Celi
- Harvard-MIT Division of Health Science & Technology, Boston, MA 02139, USA.,Intensive Care Unit, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA 02215, USA
| | - Simone Kreth
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
| | - Shahnaz Christina Azad
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
| |
Collapse
|